Committee of Public Accounts

YOUNG PEOPLE'S SEXUAL HEALTH: THE NATIONAL CHLAMYDIA SCREENING PROGRAMME

Publication of the Committee's 7th Report, Session 2009-10

Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:

“The Department of Health left it to Primary Care Trusts to organize locally all the buying and commissioning of equipment and services needed to run the chlamydia testing programme. This hands-off approach led to duplication of effort and inefficiency. And the Department did not know how much the PCTs were spending on testing or have any mechanism to measure what impact the programme was having on levels of infection.

“The Department lacked urgency in trying to reach the high volume of testing required to reduce the prevalence of chlamydia. Having decided that this was a big enough problem to warrant a national screening programme, it embarked upon a drawn out roll-out over five years. Testing was not compulsory and, by the end of that period (during 2007-08), only five per cent of 15-24 year olds were being tested, against a target of 15 per cent.

“Recognizing that this level of performance was pretty poor, the Department belatedly sprang into action in 2008-09, by imposing a mandatory target for testing levels of 17 per cent. As the PCTs scrambled to catch up, an already fragmented and inefficient programme became even more inefficient and wasteful.

“This is a classic example of what can happen when the responsibility for delivering a national initiative is pushed down to local level, with little thought about the mechanisms and interventions needed at national and regional level to maintain efficiency and momentum.”

Mr Leigh was speaking as the Committee published its 7th Report of this Session which, on the basis of evidence from the Department of Health and the Health Protection Agency, examined the delivery of the Programme, improving the efficiency of services and the Department’s approach to managing a national initiative in a devolved National Health Service.

Chlamydia is the most commonly diagnosed bacterial sexually transmitted infection and the prevalence of this infection is increasing, especially in young people under the age of 25. The infection is often symptomless but if left untreated can lead to serious health problems including infertility in women. In 2003 the Department of Health (the Department) launched the National Chlamydia Screening Programme (the Programme) which is overseen by the Health Protection Agency (the Agency) and delivered locally by the 152 Primary Care Trusts (PCTs) in England. The Programme aims to identify, treat and control the infection in young people aged under 25.

Since the Programme’s launch an estimated £100 million has been spent but the Department does not yet know what effect, if any, this has had on reducing the prevalence of the infection. During the financial year 2007-08, five years after the Programme was launched, only 5% of 15 to 24 year-olds were tested, against a target of 15%. When it became clear that very little was happening the Department introduced a new requirement for PCTs to test 17% of their 15-24 year-old population, which drove the testing rate up to around 16% in 2008-09.

The Department’s lack of urgency in pressing PCTs to reach a high volume of testing means that the Programme has not yet reached the level of activity where models predict that the prevalence of chlamydia will be significantly reduced. As a result, more young people than necessary are still being infected and potential savings to the NHS in treating the consequences of chlamydia infection have been lost.

The Department missed an opportunity to refine the Programme and to improve its cost-effectiveness, during the lengthy rollout. When PCTs increased their activity to meet the 17% target, a fragmented and inefficient programme became even more wasteful of taxpayers’ money.

The Department needs to make this Programme a national response to a national problem. The Department should identify the most cost-effective local delivery strategies, establish regional or national commissioning arrangements, increase testing numbers and measure the Programme’s impact on the prevalence of chlamydia. By improving efficiency, economies estimated at £40 million per year could be made by 2010-11.